Bacteria May Be Remaking Drugs in Sewage

June 03, 2015 |
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Story at-a-glance

The concentration of an anti-epileptic drug increased by 80 percent after going through wastewater treatment

The concentration of an antibiotic increased by 120 percent after treatment

The microbes used during the treatment process may “put back together” the broken down pharmaceuticals, resulting in increased concentrations

By Dr. Mercola

The US government advises throwing most unused or expired medications into the trash rather than flushing them down the toilet, but water testing across the US shows that no matter how the drugs are disposed, they have a tendency to end up in water.

Your trash is by no means a sealed package, so when it enters a landfill, its contents can and do mingle with other trash and its surrounding environment. Water that drains through landfills, known as leach rate, eventually ends up in rivers. And although not all states source drinking water from rivers, many do.

Further, some people do flush medications down the toilet, even though it’s not suggested. And if you’re taking medications, your body will excrete some when you use the toilet as well.

The fact that pharmaceutical drugs exist in drinking water is no secret. A 2008 Associated Press investigation found the drinking water of at least 51 million Americans contained minute concentrations of a multitude of drugs.1

Philadelphia, for instance, tested positive for 56 pharmaceuticals or byproducts in treated drinking water, including medicines for pain, infection, high cholesterol, asthma, epilepsy, mental illness, and heart problems. The city's watersheds tested positive for 63 different medications or byproducts.

Drugs in Your Water May Increase After Treatment with Microbes

Researchers from the University of Wisconsin-Milwaukee detected 48 pharmaceuticals at a Wisconsin water reclamation facility. This wasn’t all that surprising, especially since wastewater treatment plants have a difficult time removing most pharmaceuticals.

What was concerning, however, was that two of the drugs – carbamazepine, an anti-epileptic drug, and ofloxacin, an antibiotic – increased in concentration after going through the treatment process. Carbamazepine increased by 80 percent while ofloxacin increased by 120 percent; the researchers believe microbes may be to “blame.”2

Water treatment plants often use single-celled microbes to decompose organic matter in sewage. When you take a medication, your body breaks it down into different metabolites and excretes them. The microbes, it seems, then put them back together during treatment, resulting in increased concentrations of the drugs. The study’s lead author told Scientific American:3

“Microbes seem to be making pharmaceuticals out of what used to be pharmaceuticals.”

In 2008, Canadian researchers also found carbamazepine concentrations increased – by more than double – after water treatment,4 but this was largely blamed on sampling errors. The current study, however, noted a “clear upward trend over time” that suggests study errors are not to blame.5

Fortunately, not every drug is affected this way, but researchers are trying to determine why certain drugs increase while others do not. At present, the fact that carbamazepine, specifically, may increase after treatment is concerning because it’s ubiquitous in wastewater and has shown to cause tissue damage and impaired cells in carp,6 along with endocrine disruption and reproductive problems in zebrafish.7

What Happens to the Drugs in Your Gut?

If microbes in water can increase the concentration of pharmaceuticals by more than 120 percent in some cases, it begs the questions… what happens in your body when you take drugs?

Your body is in fact a complex ecosystem made up of more than 100 trillion microbes that must be properly balanced and cared for if you are to be healthy. This system of bacteria, fungi, viruses, and protozoa living on your skin and in your mouth, nose, throat, lungs, gut, and urogenital tract is unique to you.

It varies from person to person based on factors, such as diet, lifestyle, health history, geographic location, and even ancestry. Your microbiome plays an integral role in how medications react in your body, but researchers are only beginning to scratch the surface of this complicated relationship.

Just as your unique set of genes, and your expression of those genes, may predispose you to certain diseases, your microbial makeup may also increase your risk of disease, such as cancer. In the same sense, your gut microorganisms even appear to impact the efficacy of various cancer treatments.

For example, mice that received antibiotics three weeks before tumor inoculation did not respond well to the tumor immunotherapy given. Mice bred to not have gut microbes also responded poorly to the treatment.8

Even more importantly, cancer therapies that do not work by activating your body's immune response will not work unless you have the appropriate gut microbes! Such therapies, which include certain chemotherapy agents, actually rely on gut microbes to eradicate the tumor... Gut microbiota is known to affect inflammation and metabolism, both of which are hallmarks of cancer.

Your Microbiome Is Involved in Drug Metabolism

This field is so new that it doesn’t yet have a name, but “pharmacomicrobiomics” and “ pharmacometabolomics” have been suggested to describe the study of how human microbes interact with pharmaceuticals. The idea has been around for decades, but it’s only recently been receiving increasing attention. According to The Pharmaceutical Journal:9

“Several studies have shown the wide variety of effects the microbiome can have on drug metabolism. Microbes can activate or inactivate drugs, generate toxic byproducts of drug metabolism, and alter drug metabolism by human cells in both direct and indirect ways.

In many ways, the field is a natural extension of pharmacogenomics, the study of how variations in human genes contribute to individual differences in drug metabolism and effectiveness.”

Not only are drugs being developed that work by modulating the activity of your microbiome, but it’s becoming clear that an individual’s microbiome is part of the reason why drugs react differently in different people – and this must be taken into account.

The future of medicine is “personalized” medicine that will consider humans as a superorganism. For instance, for every bacteria you have there are 10 bacteriophages or viruses. So not only do you have 100 trillion bacteria, you have one quadrillion bacteriophages.

All of these organisms perform a multitude of functions in key biological systems, from supplying critical vitamins to fighting pathogens, modulating weight and metabolism, and much more, and when your microbiome falls out of balance, you can become ill.

Your microbiome also helps control how your genes express themselves. So by optimizing your native flora, you are actually controlling your genes. The Pharmaceutical Journal continued:10

“You can give two people the same drug and they will respond differently. And it’s not because of their genes but because of the genes of the microbes they carry,” says Ramy Aziz, a microbiologist in the Faculty of Pharmacy at Cairo University.

As a result, Aziz and other scientists say, the development of truly personalized medicine will have to consider humans as a superorganism, composed of ten times as many bacterial cells as human ones, and will have to take into account the idiosyncrasies not just of a single human genome but of the one to two thousand bacterial genomes that come along with it.”

Lack of Food Diversity Is Killing Humans’ Gut Flora and Leading to Disease

Modern-day diets, which are heavy on processed foods that feature limited ingredients like genetically modified corn and soy, wheat, and meat, is leading to reductions in microbe diversity in our gut.

While 80 percent of processed foods are made up of the four ingredients aforementioned, 15,000 years ago people ate about 150 different ingredients each week, according to Tim Spector, professor of genetic epidemiology at Kings College London and author of The Diet Myth.11

Spector wanted to find out what happens to your gut if you eat only fast food, specifically McDonald’s, for 10 solid days. His son, Tom, became the willing guinea pig and reported his symptoms, as well as sent stool samples to different labs, throughout the 10-day trial.

“Tom said that for three days he felt ok, but then started to become more lethargic and turned a slight gray color according to his friends. He reported feeling bad the last few days and says he also experienced some withdrawal symptoms,” TIME reported.12

Further, after 10 days of fast food, about 40 percent of his bacteria species were lost, which amounted to about 1,400 different types. Losses of microbial diversity such as this have been linked to diabetes and obesity.13 As you continue to subsist on junk food, your gut microbes respond and “bad” bacteria may proliferate, furthering your cravings for more unhealthy foods. As Spector told Food Navigator:14

“Each species of microbe has a preference for certain food sources, which allows them to feed and reproduce. They therefore have their own evolutionary drive to maintain their ecological niche and will do anything to ensure their survival. This includes sending signals to the hosting human that they want more of the same junk food that they thrive on.”

Dietary Changes Lead to Drastic Changes in Your Microflora

Your gut microbes are incredibly sensitive to what you eat. A separate study swapped the typical Western diet of a group of African-Americans with that of rural Africans (which meant swapping processed, low-fiber foods with beans and vegetables). In just two weeks, the groups took on the other’s biomarkers of cancer risk, such as bacterial activity, fiber fermentation, and intestinal inflammation.15,16

In another study, the hunter-gatherer Yanomami tribe—which had never come in contact with outsiders prior to the researchers’ arrival and had never been exposed to antibiotics—had about 50 percent greater microbial diversity than American subjects. They also had 30 percent to 40 percent more diversity than the Guahibo and the Malawi tribes, the latter two of which have adopted some Western lifestyle components, such as living indoors and using antibiotics.17 According to one of the authors:18

“As cultures around the world become more ‘Western,’ they lose bacteria species in their guts… At the same time, they start having higher incidences of chronic illnesses connected to the immune system, such as allergies, Crohn’s disease, autoimmune disorders, and multiple sclerosis.”

When you eat too many grains, sugars, and processed foods, these foods serve as “fertilizer” for pathogenic microorganisms and yeast, causing them to rapidly multiply. The best way to support microbial diversity is to eat a varied diet instead, including plenty of fiber-rich vegetables and fermented foods while avoiding antibiotics. In the not-too-distant future, however, it may not be unusual to have your individual gut microbes tested and consume a personalized probiotic product, with four or five different strains tailored to your unique microbial needs, as a result.

The Microbes in Your Gut May Even Dictate Your Weight and Your Mood

People who are obese have different gut microbes than those who are thin, and transplanting fecal matter from healthy thin people into obese people with metabolic syndrome led to an improvement in insulin sensitivity.19 In addition, according to Jeffrey Gordon, director of the Center for Genome Sciences and Systems Biology at Washington University in St. Louis, a diet high in fruits and vegetables allows microbes that promote leanness to overtake colonies of microbes that promote obesity.20

"Eating a healthy diet encourages microbes associated with leanness to quickly become incorporated into the gut," he says.

Certain probiotics are also now being referred to as psychobiotics, or "bacteria for your brain," and are being used to successfully treat depression, anxiety, and other psychiatric problems. In one study, a multispecies probiotic supplement taken for four weeks reduced cognitive reactivity to sad mood, which is a strong marker for depression (the more a person reacts to sad mood with dysfunctional thoughts, the more prone they are to a depressive episode).21,22

The strongest effects were seen for reducing rumination and aggressive thoughts. According to the researchers: "These results provide the first evidence that the intake of probiotics may help reduce negative thoughts associated with sad mood. Probiotics supplementation warrants further research as a potential preventive strategy for depression."

How to Optimize Your Microbes

All of this information should really drive home the point that optimizing your gut flora is of critical importance for disease prevention and optimal health. Reseeding your gut with beneficial bacteria is essential for maintaining proper balance here. In light of this, here are my recommendations for optimizing your microbial self:

Fermented foods are one of the best routes to optimal microbial health, as long as you eat the traditionally made, unpasteurized versions. Healthy choices include lassi (an Indian yoghurt drink, traditionally enjoyed before dinner), fermented grass-fed organic milk, such as kefir, various pickled fermentations of cabbage, turnips, eggplant, cucumbers, onions, squash, and carrots, and natto (fermented soy).

Some of the beneficial bacteria found in fermented foods are also excellent chelators of heavy metals and pesticides, which will also have a beneficial health effect by reducing your toxic load. Fermented vegetables are an excellent way to supply beneficial bacteria back into your gut. Most high-quality probiotic supplements will only supply you with a fraction of the beneficial bacteria found in homemade fermented veggies, so it's your most economical route to optimal gut health as well.

Probiotic supplement. Although I'm not a major proponent of taking many supplements (as I believe the majority of your nutrients should come from food), probiotics are an exception, especially if you don't eat fermented foods on a regular basis or if you’re taking antibiotics.

In addition to knowing what to add to your diet and lifestyle, it's equally important to know what to avoid, and these include:

Conventionally-raised meats and other animal products, as CAFO animals are routinely fed low-dose antibiotics, plus genetically engineered grains, which have been implicated in the destruction of gut flora